The Orissa Value Added Tax Rules, 2005 FORMS
-

Body

FORM VAT - 101C

DECLARATION OF PROPRIETOR / PARTNERS / DIRECTORS / AUTHORISED

PERSONS OF THE BUSINESS.

[See clause (c) of sub-rule (9) of rule 15 ]

01. Full Name: (in block letter)
02. Name of Father / Husband:
03. Date of Birth :
04. Educational Qualification:
05. Extent of interest in the business:

(i) Official designation

(ii) Date of joining in the present capacity.

06. Present Address:

07. Permanent Address:

08. PAN (Income Tax)

09. Other business interests in the state

(Specify details of such interests including relations in business)

10. Other business interests out side the state

(Specify details of such interests including relations in business)

11. Proof of Identity:

(Enclose copy of voter's Identity Card/PAN)

Specimen Signature

1. ______________________________

2. ______________________________

3. ______________________________

V E R I F I C A T I O N

I ____________________ son / daughter / wife of ___________________________ status _______ of the aforesaid business do hereby solemnly affirm that the particulars given in this form are true and correct to the best of my knowledge and belief.

Full Signature

Status with relation to the business.

Place: ___________________________